Feb 06, 2018, By: Frances MacDougall, RN
Q: What should I teach caregivers about preventing burn injuries to children five and under?
A: My experience as a clinical nurse on the burn unit at BC Children’s Hospital for 18 years made it clear to me that caregivers need more education about the common, serious and preventable causes of childhood burn injuries. Many caregivers I met over the years wished someone had told them that burns and scalds are a leading cause of childhood trauma, so the injury could have been prevented.
Scalds, which are the most common type of thermal injury for children five and under, are usually caused by hot drinks and hot tap water. Contact burns from hot appliances like stoves and glass-front fireplaces are also frequent. Young children are susceptible to such injuries because they are curious, move quickly and don’t understand the dangers.
A lot of these injuries happen because caregivers aren’t aware of the burn hazards in their home, so they don’t modify their environment or change their routines. For example, when caregivers don’t realize the glass on a gas fireplace reaches 200 C (400 F) in just a few minutes and takes 45 minutes to cool down, they don’t install a safety gate around it. Or if they don’t know that a hot beverage (still comfortable to drink) can seriously scald a child in 10 seconds, they don’t think to put it out of reach.
The most effective way to prevent these injuries is to teach caregivers the three B’s of burn prevention:
- Be aware of the common burn hazards in the home and the serious threat they pose to a child.
- Burn proof the home environment to reduce potential hazards.
- Be close. Caregivers should be within arm’s reach of a child who is near a burn hazard.
Once caregivers are aware of the burn hazards, they need strategies to make the home environment safer. Injury prevention experts find it’s easier for caregivers to understand such strategies when they’re thought of as either active or passive. Active strategies are those that must be done repeatedly, every time a hazard exists. Caregivers are using an active strategy when they opt for a travel mug to avoid a hot spill or stay within arm’s reach of a child who is taking a bath. Passive strategies are done only once. An example of a passive strategy is to lower the hot tap water temperature from 60 C (140 F) to 49 C (120 F).
When teaching caregivers about these strategies, it’s essential they understand the importance of using both types together. Passive strategies, in particular, can lead to misjudgments about safety. For instance, a caregiver may believe that with 49 C hot tap water it is safe to leave a child in the bath unsupervised. But while lowering the water temperature is an important passive strategy, the severity of a scald also depends on length of exposure. A serious scald, which will happen after one second in 60 C water, will occur in 10 minutes in 49 C water. So, as this example shows, caregivers must use the three B’s in combination and adopt active and passive strategies together — here, lowering the hot tap water temperature and remaining within arm’s reach of the child.
One more point about hot water: I use the term hot tap water because the water temperature in electric hot water tanks should not be reduced; this encourages bacterial growth. To avoid bacteria buildup, use an external mixing valve, which reduces the temperature by adding cold water to the hot.
Frances MacDougall, RN, is a clinical nurse in the post-anesthetic care unit at BC Children’s Hospital. She developed the Too Hot for Tots! early childhood burn prevention program.